Dr. Michael Blume

GLG News^SM Analyses by Michael Blume(?)

A relief, albeit a temporary one

April 14, 2008

Analysis of:Aetna to Delay Reduced Colonoscopy Coverage | online.wsj.com

This potential issue has been of concern since we changed to Propofol based anesthesia for all of our patients approximately five years ago.  We made this decision because it made endoscopic procedures significantly more tolerable (essentially painless, except for the bowel prep) for just about all of our patients, as well as, frankly, safer.  While many patients did well with standard conscious sedation using agents such as Sublimaze and Versed, others did not do as well.  Using an anesthesiologist benefited not only high risk patients, but also patients who had rather high sedation tolerances, who often were difficult to identify prior to performing the procedure. 

Important data in a difficult to treat subpopulation

December 17, 2007

Analysis of:Study Data Show Asacol(R) (Mesalamine) is Effective in Treating All Extents of Ulcerative Colitis Including Isolated Proctitis | www.prnewswire.com

Patients with isolated proctitis remain a difficult to treat subpopulation of patients with UC.  Topical mesalamine is often efficacious, but is not always the preferred mode of administration for many patients.  As we have a variety of options as to which oral mesalamine preparation to use in our patients, seeing data on treating proctitis can be useful in making a decision as to which one to use.

A small niche in the PPI market

December 10, 2007

Analysis of:Wyeth Receives FDA Approval of Protonix for Delayed-Release Oral Suspension | pharmalive.com

Which PPI to prescribe?  We already have a myriad of choices between brands, which in general, are all quite effective when used for the correct indications.  An oral suspension is useful in a patient who requires PPI therapy, but who is unable to swallow pills for a variety of reasons.  This scenario, however, represents a very small percentage of the large patient population who are on PPI's.  This formulation would be unlikely to dramatically affect prescribing habits for most physicians in the community.

Clinical data not surprising, cost data may be misleading...The question is when to use Remicade and in whom.

October 29, 2007

Analysis of:Clinical Studies Show REMICADE® Reduces Incidence Of Bowel Surgeries In Ulcerative Colitis Patients | www.medicalnewstoday.com

The clinical outcome information in this report regarding decreasing colectomy rate is not particularly surprising, but the cost statements may be misleading.  One wonders if the increased health care costs in the colectomy group reflect that fact that the observation period was only twelve months, and is skewed because of issues involving the immediate post-op period.  One should be looking at cost related issues in the long run, and would expect that five years down the line, for example, given the costs involved with drug therapy and monitoring patients with IBD and the fact that colectomy in UC is curative, the costs in the colectomy group would be significantly lower.  Remicade has been an important addition in how we treat inflammatory bowel disease for some time, and has been FDA approved for use in UC for several years now. It has allowed us to not only get more patients into remission, but also keep patients in remission and decrease steroid usage.

A potentially welcome addition to managing a difficult problem, but response rate is not overwhelming

October 29, 2007

Analysis of:FDA Accepts Sucampo's SNDA For Lubiprostone (8 Mcg) For The Treatment Of Irritable Bowel Syndrome With Constipation (IBS-C) | www.medicalnewstoday.com

Constipation predominant IBS is an extremely common problem, which while not life threatening, interferes significantly with daily function in many people.  We have very few effective drugs (especially since Zelnorm was taken off of the market) for this condition.  Lubiprostone may be a welcome addition to what are limited therapeutic options, however its efficaciousness, while statistically better than placebo, is not overwhelming.  Its utility may be limited by its limited efficaciousness, pregnancy concerns (it is category C, and many patients with this disorder are young females), and cost.  It will probably have a place, however, in how we treat some patients with this disorder, either as a stand alone drug, or part of some type of combination regimen.

View All GLG News ^SM Analyses by Michael Blume